Remote Claims Processor - Accurate Adjudication & QA

Highmark Health; Boston (MA); Remote; USD 27,000 - 33,000; Full time

Job summary

Highmark Inc. in the United States is seeking a qualified claims processor to screen, review, and adjudicate medical claims and correct errors for accurate processing according to policy. This remote role emphasizes timely action and customer interaction with internal teams.

The candidate will verify data, determine eligibility, resolve edits, and support audits. A High School Diploma is required; 1 year of billing experience is preferred. Strong communication and math skills are essential.

Qualifications

• High School Diploma or GED required.
• Experience in claim billing or processing preferred (1 year).

Responsibilities

• Receives and processes claims data; verifies completeness and accuracy.
• Resolves edits, determines benefit eligibility and final payment.
• Elevates issues with professional communication to supervisors.
• Meets production and quality standards; maintains records and training attendance.
• Performs other duties as assigned.

Skills

Strong communication

Multi-system navigation

Mathematics for adjudication

Problem solving

Claims processing knowledge

Education

High School Diploma/GED

Job description

Highmark Inc. in the United States is seeking a qualified claims processor to screen, review, and adjudicate medical claims and correct errors for accurate processing according to policy. This remote role emphasizes timely action and customer interaction with internal teams.

The candidate will verify data, determine eligibility, resolve edits, and support audits. A High School Diploma is required; 1 year of billing experience is preferred. Strong communication and math skills are essential.